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Breakthrough Bleeding

While regular menstrual cycle control is one of the major benefits of using oral contraceptives, breakthrough bleeding-spotting between predicted menstrual periods-is one of the common and annoying side effects of birth control pill usage. According to a study published in the American Journal of Obstetrics and Gynecology (1998), breakthrough bleeding is the number one reason women stop taking the Pill. Women who desire oral contraception should know that this is not their only alternative if they have experienced breakthrough bleeding. While we loosely refer to all oral contraceptives as "the Pill", there are numerous options with different formulations. Women should also know that according to a study published in the Journal of Reproductive Medicine in 1995, more than 600,000 unintended pregnancies result per year in the United States as a result of women who discontinue birth control pill use, yet fail to use an equally reliable contraceptive method. While that number may be smaller now as a result of more available contraceptive options (including the contraceptive patch and emergency contraception), it is still way too high.

Women need to understand that while breakthrough bleeding is not uncommon during the first three cycles of birth control pill usage, it usually resolves without intervention. Women who have repeated episodes of breakthrough bleeding should be comforted to know that the solution is often switching to another birth control pill with a higher estrogen content. Most women currently taking birth control pills are on "low-dose" or even "very low-dose" estrogen-containing pills. While this minimizes many other side effects, women with breakthrough bleeding may simply require more estrogen. This rarely means that they will be taking a "high estrogen" pill, but simply a more appropriate dosage for their body's specific needs. Studies have shown that the lower the estrogen levels a particular pill, the higher the rates of breakthrough bleeding and spotting. In addition, women who smoke are more likely to have breakthrough bleeding, as well as to be at higher risk of serious cardiovascular side effects with higher doses of estrogen (especially in women over age 35).

Created: 3/17/2004  -  Donnica Moore, M.D.

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